Transcript Health Inequalities - CityWide

A health led approach to drug use in Ireland - what does it mean?
Citywide Drugs Crisis Campaign Conference 2016
A Social Inclusion pillar for the National Drugs
Strategy?
Dr Aileen O’Gorman
University of the West of Scotland
Aileen.O’[email protected]
 The majority of people who use drugs do not use
them problematically and do not develop a
physical dependence (Drug Policy Alliance)
 There is a difference between drug use and
problem drug use and drug-related harms
 Not everybody accepts or is comfortable with this
 But, if we accept the differentiation; decriminalise
use; and focus on health and social policy
responses maybe we can move forward?
Lots of research with similar recommendations
2014
Evidence
 Some social groups (unemployed, living in
social housing or in lone parent households,
experiencing educational disadvantage )
experience unequal and much higher rates of
poverty than others.
 Drug use disproportionally harms people who
experience challenging lives rooted in poverty
and inequality
Risk environments
 drug-related harms cluster in communities shaped
by disadvantage and inequality
 DATF areas home to disproportionate rates of
vulnerable social groups (over 60% in some areas).
 Policy-related harms or ‘policy induced losses’:
-
the negative outcomes for people resulting from
decisions taken, or not, by national and local
government and statutory agencies.
Impact of recession
 Increased levels of poverty and inequality since
‘Great Recession’ began 2008
 Nationally, deprivation rate (doing without
essentials) increased from 12% -> 31%.
 For example, the number of people registered as
unemployed in Clondalkin trebled from 3,500 to
10,000 in the first three years of recession
(O’Gorman et al., 2016).
Unequal experience of the Great Recession
Unemployment
3rd Level Ed
2006
2011
Area A
22.0%
43.0%
Area B
5.2%
6.3%
Area A
6.3%
4.7%
Area B
78.1%
84.0%
Source:
http://www.instituteofhealthequity.org/presentations/presentation-slides
Young people – advanced marginality
 Challenge of growing up in a high risk environment
 Decreasing level of resources to support youth educational difficulties; behavioural issues; poor
mental health – self-harm, suicides
 Drugs economy one of the few employment and
economic opportunities for young people
 Labour force for drugs economy (storing, bagging,
delivering drugs and money to make additional
money and pay back debts)
Impact of drug economy
 Expansion of drugs economy during economic
boom (increased drug use nationally)
 Operation of drugs economy has destabilising affect
in area
 Hidden economy – high level of systemic violence
settling disputes over debts, suspected informants,
stolen or seized consignments of drugs
 State response a form of structural violence:
- the avoidable impairment of fundamental human
needs (Galtung).
 Politics of austerity – reductions and restructuring
of education, housing, welfare as well as supports
for community and voluntary sector.
 Disproportionally affects the less well off, the
vulnerable (Harvey).
 For example, cuts to supplementary welfare – important
cushion against poverty
 Serves the interests of the dominant classes
A health-led approach to drug
use would provide an opportunity
to address the social and
structural determinants of drugrelated harms
Social gradient of health
 ‘social class position undoubtedly plays a causal
role in the distribution of health and disease in
human populations’ (Cockerham, 2012)
 people who are less (socioeconomically)
advantaged have worse health (and shorter lives)
than those who are more advantaged
 Social gradient of health = each successively
more advantaged group has longer life
expectancy and better health.
Social and structural determinants of health
(and health inequalities)
Health Inequalities are recognised already by the
government. The Department of Health website states:
 Inequalities in health … between different population
groups due to the conditions in which people are
born, grow, live, work, and age … there is an uneven
distribution of the risk factors … with the burden
borne disproportionately by those in the lower socio-
economic groups … One of the goals of Healthy
Ireland is to reduce health inequalities.
http://health.gov.ie/healthy-ireland/health-inequalities/
Health Inequalities
 ‘Inequalities in health arise because of
inequalities in society – in the conditions in
which people are born, grow, live, work and
age’ (Marmot, 2010)
 The causes of health inequality are complex
but they do not arise by chance.
 The social determinants of health are
largely the results of public policy.
Putting a spotlight on the role
of policies (and power) in
creating the conditions for
inequalities in health and drugrelated harms
Policy harms
 Little attention is paid to the role politics and
policies play in shaping poverty and inequality.
 Growing sense that drug policy does not affect
rates of drug use
 Latest lifetime prevalence figures 2014/15
 54% of 25-34 year old males use illegal drugs
 60% of 25-34 year old males use tobacco
How do we move forward?
 How can social and structural determinants of
drug-related harms be addressed in the new
National Drugs Strategy?
 On the one hand, the Drugs Strategy is located
within a social inclusion framework.
 But, notable policy shift towards viewing drug use
as an individual behavioural issue with an
increasing focus on individual’s social deficits
rather than policy deficits
National Drugs Strategy
Cross-cutting area of public policy brings together
Departments, agencies and the community and voluntary
sectors to provide a collective response to tackle the harm
caused to individuals, families and communities by problem
drug and alcohol use in Ireland through the five pillars of:
1.Supply reduction
2.Prevention
3.Treatment
4.Rehabilitation and
5.Research
 NDS contains 63 actions to be taken across the full range
of Departments and agencies involved in delivering drugs
policy to ensure that the aims and objectives of the
Strategy are met. Annual reports on progress –
 Oversight Forum on Drugs – chaired by the Minister with
responsibility for the National Drugs Strategy oversees
progress in relation to the actions of the Strategy and
address any emerging issues.
 OFD reports to the Cabinet Committee on Social Policy,
Advantages of a Social Inclusion pillar
 Evidence-based social and structural determinants of
problem drug use and drug-related harms could be clearly
specified
 Series of actions and Key Performance Indicators (KPIs)
could be identified to address these
 Progress on actions / KPIs can be monitored
 Public policies could be ‘drug proofed’ – that is, they can be
checked to see if they would have a negative impact on
drug-related harms. For example, a decrease in resources for School
Completion Programmes would impact on early school-leaving rates – a key
 It is an effective and value for money (VfM) policy
response as it avoids policies cancelling each other out.
For example, the benefit gained from a positive policy
such as Minister Byrne’s allocation of an additional €3m
in Budget 2017 to support drugs and social inclusion
measures is cancelled out by negative housing policies
and the continuing crisis in housing and homelessness
– key determinants of problem drug use.
Recommendations for the
National Drugs Strategy
Let’s try something
different ….. !
Drug-related harms
 Stigma
 Overdoses
 Ill health
 Drug related deaths
 Family and relationships fracture
 Crime
 Violence associated with drugs economy
 Fear
 Over policing and under protection – still?
Impact of austerity
National Deprivation
rate
Unemployed: ‘at risk’
of poverty
Unemployed: in
consistent poverty
2007
12%
2013
31%
23%
37%
10%
24%
Key Point: - Programme of austerity has
adversely affected most vulnerable groups
and the community and voluntary sector
Biggest policy induced losses
References
 Cockerham, W.C., (2012) Social Causes of Health and
Disease, 2nd ed., Cambs, UK: Polity Press